IAVI Responds to Lancet Article on Intensive Testing and Treatment

November 26, 2008

On Nov. 26, the Lancet published a paper by Reuben Granich et al exploring through a mathematical model the theoretical effect on the AIDS epidemic of an intensive program of HIV testing and treatment. The authors explored what might happen in a community if every individual above the age of 15 voluntarily received an HIV test every year and those who proved to be HIV-infected were immediately put on anti-retroviral therapy (ART) and stayed on it. The authors concluded that this strategy could virtually eliminate the AIDS epidemic in that community within 10 years.

Responding to the article, IAVI President and CEO Seth Berkley said, “The Lancet piece represents two things the field of AIDS prevention needs: out-of-the-box thinking and a focus on ending and not just ameliorating the AIDS pandemic. The authors’ work is a provocative exercise looking beyond current strategies to address AIDS. As the authors suggest, the ideas behind their model should be explored further.

“The model, as constructed, however, would seem to be limited in its applicability to actual circumstances. It’s not clear how public health officials would see to it that everyone is tested annually for HIV when today an estimated 80% of HIV-infected adults in sub-Saharan Africa are untested. Or how officials would get ART immediately to all those who are infected when today in much of sub-Saharan Africa, fewer than 20% of those infected are on ART. AIDS programs already take up about a fifth of all overseas development assistance.

“We need real-world solutions to combat AIDS. Antiretroviral drugs improve and prolong the lives of those who are HIV infected, but they are not cures and they don’t represent a long-term solution to the AIDS problem. Current prevention methods have helped to stabilize HIV transmission rates in many places but at shockingly high levels. Today, 33 million people on the planet are HIV infected, and 7,500 become HIV infected every day. Clearly, we need better means of stopping people from becoming HIV infected in the first place, such as microbicides, pre-exposure prophylaxis and preventive vaccines.

“Vaccines are the cheapest and most effective means medicine has for coping with infectious disease. Scientific evidence suggests an AIDS vaccine is possible. And researchers today are following new leads that offer fresh promise in AIDS vaccine development.”